Sunday, January 07, 2007

Yupik Eskimo Diet and Obesity


Obesity and diabetes used to be virtually unknown among the Yupik Eskimos of southwest Alaska. Their traditional diet reflects their hunter-gatherer lifestyle: it consists mostly of meat, fish, berries, and a limited selection of greens and vegetables that grow wild on the tundra. Some Yupiks still eat a predominantly traditional diet, and have little trouble with obesity.

The infiltration of Western culture into this region has brought many changes, most of them good. Medical care is far more accessible; infant mortality rate and death from infectious disease are greatly reduced. Transportation and communication are much faster and easier. Availability of goods and services from outside the region is greatly improved. The arrival of the Western diet, however, has had deleterious effects on the health status of the Yupiks.

Western culture got its first modern-day toehold in this region about 150 years ago, with the arrival of the Moravian missionaries in the 1860s. For the first hundred years or so, the number of Caucasians was small enough to have little effect on the Yupik culture outside of the religious arena. Fifty years ago, the only noticeable effect of Western presence on diet was the addition of flour, sugar, and margarine, available from the white traders. Bread, either fried or baked, thickly spread with margarine and topped with sugar became the usual breakfast of many Yupiks.

In the 1950s, Bethel had a population of about 800 people, of which less than 20% were non-Native. Today Bethel’s population approaches 6,000, and half are non-Native. This influx represents a huge injection of Western culture in the region. From a dietary perspective, this means soda pop and candy in the grocery stores, and hamburgers and pizza in the restaurants.

The effects are felt in the villages as well as in Bethel. Almost every village has a store or trading post which sells canned and packaged foods which are ordered from the stores in Bethel or Anchorage. By far, the most-shipped item by weight is soda pop. Tons of it are shipped to the villages every year. It is not uncommon to find children who drink six or eight cans daily. Combined with candy and irregular tooth-brushing behaviors, the effect on their teeth is predictable. Many children here have full-mouth silver capping of their deciduous teeth, done in the OR under general anesthesia.

The other effect of so much sugar in the diet is obesity. It has practically exploded as an epidemic in the Yupik population in the last twenty years. Of course, sugar is not the only culprit. Pasta, rice and Crisco have also become staples of the Yupik diet.

Activity levels in daily life have also changed with the advance of Western culture. Snowmachines and four-wheelers have decreased the amount of walking that most people do, and there are far fewer dog teams to care for because of them. There is less need for chopping wood and hauling water with the advent of oil-burning stoves and indoor plumbing. Children’s entertainment more often involves television and video games than active physical activity.

The Yupik people as a whole tend to put on excess weight as truncal obesity—the classic “apple” shape. They refer to themselves as “top-heavy” when they are obese. A three hundred pound woman may be huge from shoulders to hips, but have relatively skinny arms and legs and practically no butt. When she sits, her pannus may come nearly to her knees. Overall, the Yupik are also fairly short people; average height for women is 60-62 inches, for men 64-66 inches.

One of the strategies for making inroads into the obesity epidemic among the Yupik is to encourage a return to traditional culture. “Stop eating Western junk food, you weren’t made for it; eat your traditional diet,” is what we advise. There is a strong resurgence of pride in their culture going on, and many younger people want to focus on this. The difficulty is that their traditional diet is a lot more work to acquire. The grocery stores don’t sell moose, beaver, swan or salmonberries. Dried pasta, on the other hand, is cheap, light to pack and has a shelf-life of years.

The diabetes education team is working hard to bring home the message about the connection between obesity and diabetes. The team includes a registered dietician who helps people adapt ADA (American Diabetic Association) recommendations to the Native lifestyle. They have folks wearing pedometers and striving for “thirty actives minutes per day”. Bethel residents are encouraged to join Weight Watchers and to participate in the hospital’s Biggest Loser program.

In short, the obesity epidemic which is overtaking Americans is not limited to the lower 48 or to the non-Native populations. An endless supply of cheap food which is always available, combined with decreased activity levels overall, has gradually fattened us as a nation. A tendency to turn to food for comfort in times of stress, isolation or despondency contributes to the fattening in the high-stress times we live in. The bottom line is as simple as it is difficult. Eat less. Exercise more. And curse your genes if you come from a long line of fat people.

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12 Comments:

Blogger Shinga said...

It's more 'curse your genes' in a particular context of history isn't it? In many parts of the world, much of the population has food insecurity: according to a recent item in the NYT, India has the problem wherein 1 in 5 of its children is obese while 1 in 3 has too little to eat and is malnourished.

In Fogel’s The Escape from Hunger and Premature Death, 1700-2100, he argues that until comparatively recently, most people were battling a series of infections almost all the time, and that people (particularly children) expended a substantial amount of their calorie intake on fighting infection. It is a relatively recent development that we are so secure in our access to adequate calories that we can now concern ourselves with details of our diet.

I can completely understand why we may have a genetic attraction to calorie dense foods if we needed calories to fight infections or assuage stress. I suppose our genes just can't adapt to the contextual information that we are currently 'food secure'.

Regards - Shinga

Monday, January 08, 2007 3:30:00 AM  
Blogger Sarah said...

In Australia Aboriginal people have similar problems. In remote areas fresh produce tends to be very expensive (when it is even available), but the same problems with health and diet are prevalent in cities as well. Combined with the high rate of smoking it has resulted in a huge disparity in the life expectancies of aboriginal and non-aboriginal Australians.

It sounds like you guys might be more advanced in tackling the situation than we are here in Australia. Despite government awareness of the problem there doesn't seem to be much yet in the way of action.

I think the 'cultural pride' approach is a good one for some communities, but a much greater level of education is needed regarding the selection of foods that are more widely available, and increasing the amount of non-junk food available at community stores here.

I would also imagine that it must be awfully difficult maintain even a moderate level of physical activity during the winter where you are?

Monday, January 08, 2007 1:32:00 PM  
Blogger Norma said...

Interesting post. But also in the lower 48, 50 years ago, most people also hadn't tried pizza. I had my first taste in 1957. And only milk was sold in schools.

Monday, January 08, 2007 3:09:00 PM  
Anonymous Pete from kasigluk said...

Another reason for the popularity of pop is the lack of running water. When you have to haul all of your water, pop becomes doubly attractive.

Tuesday, January 16, 2007 6:55:00 AM  
Anonymous Anonymous said...

Great article! it helped me alot with my research. Thanks so much.

Wednesday, October 24, 2007 4:19:00 PM  
Anonymous Anonymous said...

I really appreciated reading this article because i am Yupik and i am obese and most likely have Diabetes......this article has helped me understand a few more things.....thanks!

Friday, March 07, 2008 6:56:00 AM  
Blogger The Tundra PA said...

Anon 3/7/08--quyana cak nek for your comment! If you do have diabetes or pre-diabetes, it is important to get seen and screened and counseled and if necessary, treated. Come and see me at the hospital, I would love to help you if I can.

Friday, March 07, 2008 8:08:00 AM  
Anonymous Anonymous said...

When compared to other drinks, price per ounce, soda is by far the cheapest drink available in the villages. It is not uncommon for a gallon of milk to cost well over $7.

Thursday, November 20, 2008 2:53:00 PM  
Anonymous Anonymous said...

This would be a very interesting area of study particularly in the areas of Essential Fatty Acids (esp. omega-6 and omega-3), salt, sugar and grain and the implications for well being in North America, United Kingdom, and a sizable chunk of Europe.

The modern 'western' diet is overabundant in omega-6 and deficient in omega-3. Dietitians are telling us these EFAs are important but the message that these EFAs have to work together is not pressed home to ordinary Joes like me. In the metabolism these guys facilitate a regulatory process
and counterbalance each other. They're a bit of a balancing double act and the dietary balance between the two is important.
For arguments sake, if the optimal ratio of omega-6 to omega-3 is 2:1 then with the 'innovations' and industrialisation of our 'western' diet leading to, for one example, the prevalence of vegetable oils and derivatives, we have unwittingly upset that balance. When studied in populations omega ratios vary enormously but seemingly significant numbers of people in the west measure at 20:1 (or worse) when studied. There are metabolic and behavioral implications.

The official stance on Salt here in the UK is not to ingest more than 6g daily. The argument is that salt raises BP. Omega-3 is thought to be a factor regulating BP. Reading the label on a tin of Sardines yesterday I mused, 'Hmm, fish are quite salty'. They're also the best source of some EFAs Could it be that our tolerance to salt would be greater within the parameters of optimal omega-6 and omega-3?

Obesity leads to (type 2) diabetes?
Diabetes UK, our UK health service and general practitioners are still peddling this myth.
No!
The quantum leap in thought to the notion that type 2 diabetes and obesity are simply different manifestations of the same metabolic 'illness' that arises from the long term effects on human metabolism when people deviate by too far and for too long from their 'ancestral' diet; meaning the diet that our evolutionary path has determined is optimal for us.
Supposedly modern food 'innovations' in the western diet (meaning over dependency on high GI / high GL grain and derivatives, high inclusion of vegetable oils leading to disruption in the 'omega balance', an over abundance of sugar and/or sweeteners, agricultural methods and degradation of nutrient values, and over dependency on food processing) are at the very root of a host of modern health issues including CHD, obesity, mental illness, behavioral problems, learning difficulties and my own cross to bear, type 2 diabetes.

Wednesday, January 07, 2009 3:33:00 AM  
Anonymous Anonymous said...

When America has health issues they adhere to what is available in the common grocery stores. It's not that Natives love pop and are lazy to haul water as most people or educated people think in rural Alaska, but it's rather availability. Advertising to young people, and making it cheap is monopoly. ERRR!!

Saturday, April 25, 2009 10:18:00 PM  
Anonymous Anonymous said...

I remember, as a little kid, that seal oil was such a special treat( we were in the states) that the adults would only give us tastes of it. on pilot bread. I tried to immatate this by drinking crisco oil. As a young teen, living in Alaska, my friends would offer me crisco coated hard tack, oftentimes with sugar sprinkled on top.
'Agutuk' is made with crisco, salmon, berries and sugar.
Why are Eskimos so fat? I feel it's the adverts, and the easyness of just such foods. Processed things. Think also, that culture too is on this. This article just culminates all the things I have felt for years. so sad.

Friday, May 15, 2009 1:22:00 PM  
Anonymous Healthy Food to Lose Weight said...

Obesity and diabetes go hand in hand. If you do not consume breakfast on a daily basis or in time, there is higher risk of diabetes. Food imbalances, and insulin imbalance leads to diabetes. It is definitely curable.

Sunday, November 24, 2013 9:12:00 PM  

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